Missed injuries in trauma patients: A literature review

<p>Abstract</p> <p>Background</p> <p>Overlooked injuries and delayed diagnoses are still common problems in the treatment of polytrauma patients. Therefore, ongoing documentation describing the incidence rates of missed injuries, clinically significant missed injuries, contributing factors and outcome is necessary to improve the quality of trauma care. This review summarizes the available literature on missed injuries, focusing on overlooked muscoloskeletal injuries.</p> <p>Methods</p> <p>Manuscripts dealing with missed injuries after trauma were reviewed. The following search modules were selected in PubMed: Missed injuries, Delayed diagnoses, Trauma, Musculoskeletal injuires. Three time periods were differentiated: (n = 2, 1980–1990), (n = 6, 1990–2000), and (n = 9, 2000-Present).</p> <p>Results</p> <p>We found a wide spread distribution of missed injuries and delayed diagnoses incidence rates (1.3% to 39%). Approximately 15 to 22.3% of patients with missed injuries had clinically significant missed injuries. Furthermore, we observed a decrease of missed pelvic and hip injuries within the last decade.</p> <p>Conclusion</p> <p>The lack of standardized studies using comparable definitions for missed injuries and clinically significant missed injuries call for further investigations, which are necessary to produce more reliable data. Furthermore, improvements in diagnostic techniques (e.g. the use of multi-slice CT) may lead to a decreased incidence of missed pelvic injuries. Finally, the standardized tertiary trauma survey is vitally important in the detection of clinically significant missed injuries and should be included in trauma care.</p

Topikal hemostatik ajanların travmalı olgularda güncel kullanım esasları

ÖZETSivil ve askeri travmalarda önlenebilir ölümlerin en sık nedeni kanamalardır. Özellikle ekstremitelerde meydanagelen yaralanmalarda basit kanama kontrolü ve turnike uygulanabilirken aksiller ve femoral bölge yaralanmalar›nda hemostaz zor sa¤lanmaktad›r. Bu yaz›da posttravmatik kanamal› olgularda kullan›lmas› önerilen topikal hemostatik ajanlar›n literatür eflli¤inde gözden geçirilmesi amaçland›. Topikal hemostatik ajanlarla ilgili mevcut bilgilerin,az say›da olgu sunumuna, ço¤unlu¤u deneysel çal›flmalardan elde edilen verilere ve sahraya ait baz› kiflisel yorumlara dayand›¤›, ürünler aras›nda klinik kullan›m›na ait ileriye dönük randomize kontrollü çal›flmalara rastlanmad›¤›gözlendi. Kanamaya ba¤l› geliflen mortaliteyi azaltmaya yönelik topikal hemostat uygulamas›na dair de¤erlendirmelerin yüksek kan›t düzeyli çal›flmalar ile desteklenmesine ihtiyaç duyulmaktadır. Anahtar sözcükler: Topikal hemostat; kanamaSUMMARYHemorrhage is the most common cause of preventable deaths both in civilian and military trauma. Simple hemorrhage control and tourniquets can be applied in extremity injuries but hemostasis in the axillary and femoralregion is rather challenging. In this study, results on the efficacy of topical hemostatic agents in post-traumatichemorrhages reported in the literature are reviewed. As conclusion, current information on topical hemostaticagents depend upon a few case reports, data from mostly experimental studies and subjective evaluations in thefield, but there are no prospective, randomized studies with control group. Evaluations regarding the use of topical hemostatic agents to reduce the mortality need to be supported by studies with higher level of evidence.Key words: Topical hemostat; hemorrhage.</p

Ultrasound lung "comets" increase after breath-hold diving.

The purpose of the study was to analyze the ultrasound lung comets (ULCs) variation, which are a sign of extra-vascular lung water. Forty-two healthy individuals performed breath-hold diving in different conditions: dynamic surface apnea; deep variable-weight apnea and shallow, face immersed without effort (static maximal and non-maximal). The number of ULCs was evaluated by means of an ultrasound scan of the chest, before and after breath-hold diving sessions. The ULC score increased significantly from baseline after dynamic surface apnea (p = 0.0068), after deep breath-hold sessions (p = 0.0018), and after static maximal apnea (p = 0.031). There was no statistically significant difference between the average increase of ULC scores after dynamic surface apnea and deep breath-hold diving. We, therefore, postulate that extravascular lung water accumulation may be due to other factors than (deep) immersion alone, because it occurs during dynamic surface apnea as well. Three mechanisms may be responsible for this. First, the immersion-induced hydrostatic pressure gradient applied on the body causes a shift of peripheral venous blood towards the thorax. Second, the blood pooling effect found during the diving response Redistributes blood to the pulmonary vascular bed. Third, it is possible that the intense involuntary diaphragmatic contractions occurring during the "struggle phase" of the breath-hold can also produce a blood shift from the pulmonary capillaries to the pulmonary alveoli. A combination of these factors may explain the observed increase in ULC scores in deep, shallow maximal and shallow dynamic apneas, whereas shallow non-maximal apneas seem to be not "ULC provoking".Clinical TrialJournal Articleinfo:eu-repo/semantics/publishe